NPIMap

Organization Active NPI

Oglethorpe of Port St Lucie LLC

  • Psychiatric Hospital
  • Port St Lucie, FL
National Provider Identifier
1093748162
Registry record updated Jan 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric HospitalTaxonomy code 283Q00000X
Legal business name
OGLETHORPE OF PORT ST LUCIE LLC
Practice address
2550 SE Walton Rd
Port St Lucie, FL 34952-7168
Phone
(772) 335-0400
NPI assigned
Jul 9, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 21, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Tracy A Roberts
Title
Corporate Director Revenue Cycle
Phone
(423) 895-0084

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital 283Q00000X Primary

Addresses

Primary practice location

2550 SE Walton Rd
Port St Lucie, FL 34952-7168

Mailing address

2550 SE Walton Rd
Port St Lucie, FL 34952-7168
Phone (772) 335-0400

Other names 1

  • PORT ST LUCIE HOSPITAL Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20060822000158 FL Part A Provider - Hospital 8224031828 Practice locations: Port St Lucie, FL
O20090309000628 FL Part B Supplier - Clinic/Group Practice 8224031828 Receives reassigned benefits from 4 practitioners
Practice locations: Port St Lucie, FL

Hospital certification: CCN 104070

Legal name
OGLETHORPE OF PORT ST LUCIE LLC
Doing business as
PORT ST LUCIE HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Psychiatric
Participating since
Oct 10, 2006
Last certification
Jul 27, 2012
Beds
75
Ownership / control type
Private (for profit)
Organization structure
LLCProprietary
Incorporated
Oct 19, 2005 in FL
Enrollment address
2550 SE Walton Rd
Port St Lucie, FL 34952-7168
Other Hospital Practice Location
Hospital subgroups
Psychiatric

Hospital certification: CCN 104036

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
SAVANNAS HOSPITAL
Certification status
Terminated Voluntary: merger or closure, Jul 27, 2006
Provider type (POS)
Hospital – Psychiatric
Participating since
Mar 23, 1987
Last certification
Mar 21, 2002
Beds
70
Ownership / control type
Private (for profit)
Facility address
2550 SE Walton Rd
Port Saint Lucie, FL 34952

Care Compare: Hospital

Medicare Care Compare
Listed as
Port St Lucie HospitalCCN 104070
Type
Psychiatric
Ownership
Proprietary
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D1073002Port Saint Lucie Hospital2550 SE Walton Rd, Port Saint Lucie, FL 34952Certificate of waiverAug 28, 2027

National Provider Directory

National Provider Directory

Locations

18302 Highwoods Preserve Pkwy
Ste 114
Tampa, FL 33647
Phone (727) 934-3223

Networks

  • Optimum HealthCare HMO NetworkPlans: Optimum Diamond Rewards (HMO C-SNP) (H5594-028-000, H5594); Optimum Diamond (HMO C-SNP) (H5594-036-000, H5594); Optimum Diamond Rewards (HMO C-SNP) (H5594-034-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-029-000, H5594); Optimum Platinum Plan (HMO) (H5594-002-000, H5594); Optimum Gold Plus Plan (HMO) (H5594-032-000, H5594); Optimum Diamond Savings COPD (HMO C-SNP) (H5594-031-000, H5594); Optimum Diamond Savings (HMO C-SNP) (H5594-030-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-035-000, H5594)
  • HealthSun Health Plans Network
  • Freedom Health HMO NetworkPlans: Freedom Platinum Rewards Plan Rx (HMO) (H5427-102-000, H5427); Freedom VIP Care (HMO C-SNP) (H5427-070-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-108-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-099-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-107-000, H5427); Freedom Maximo (HMO-POS) (H5427-113-000, H5427); Freedom Savings Plan (HMO) (H5427-052-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-096-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-105-000, H5427); Freedom Medi-Medi Full (HMO D-SNP) (H5427-087-000, H5427)…

Ownership & related parties

All disclosed owners & managing parties 8

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Mercy Estevez Individual W-2 Managing EmployeeAd; Apr 1, 2024 5%
Oglethorpe Inc Organization, Brooksville, FL Corporation 5% Or Greater Direct Ownership Interest Oct 19, 2005 100%
Operational/Managerial Control Oct 19, 2005 100%
Warren Knight Individual Corporate OfficerCfo Jun 1, 2008 1%
Operational/Managerial ControlCfo Jul 1, 2020 5%
Robert M Cohen Individual 5% Or Greater Direct Ownership Interest Oct 19, 2005 100%
James E Oshea Individual Corporate OfficerCoo Oct 19, 2005 5%
James Coyle Individual W-2 Managing EmployeeSenior Accountant Jun 10, 2024 2%
John R Picciano Individual Corporate OfficerPresident Oct 19, 2005 5%
Joel Snook Individual Operational/Managerial ControlCorporate Director of Operations Nov 30, 2022 5%

Facilities with the same owner 3

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152403200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1737417600000",
    "number": "1093748162",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2550 SE WALTON RD",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349527168",
            "telephone_number": "772-335-0400",
            "fax_number": "772-337-3124"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2550 SE WALTON RD",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349527168",
            "telephone_number": "772-335-0400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OGLETHORPE OF PORT ST LUCIE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-09",
        "last_updated": "2025-01-21",
        "certification_date": "2025-01-21",
        "status": "A",
        "authorized_official_last_name": "ROBERTS",
        "authorized_official_first_name": "TRACY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CORPORATE DIRECTOR REVENUE CYCLE",
        "authorized_official_telephone_number": "423-895-0084",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "283Q00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Hospital",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PORT ST LUCIE HOSPITAL",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Port St Lucie, FL

Sources for this page

Verify at the official NPI Registry.